Fostering trust through surgical ethics

Surgical ethics, a relatively recent concept within the field of medical ethics, is a crucial part of being a complete surgeon, according to Peter Angelos, MD, PhD, FACS, Linda Kohler Anderson Professor of Surgery and Surgical Ethics, Chief of Endocrine Surgery, and Associate Director of the MacLean Center for Clinical Medical Ethics, University of Chicago, IL. A complete surgeon, he said during a Wednesday lecture, is one who “is technically excellent but who is also a great doctor who is thinking about the patient in a broader context, with respect to their values and their goals.”

Dr. Angelos discussed the importance of trust in the surgeon-patient relationship, describing how this relationship has evolved over time. Before anesthesia, speed was critical to a surgeon’s success. After anesthesia came into use, finesse and meticulous technique became the currency of a successful practitioner. The innovation also elevated the importance of trust, he said, “because the vulnerability is so much higher.”

Trust also plays a significant role in shaping the quality of informed consent, which for surgery means explaining the risks, benefits, and alternatives for a particular procedure. While data show that most patients do not remember what they are told during the consent process, those who trust their surgeon still report high satisfaction with this interaction. “Information transfer is not the true measure of success of informed consent,” Dr. Angelos argued. “I would say that patient trust transcends these problems with memory, and I think that in fact it’s trust that is the basis of informed consent.”

Dr. Angelos put out a call to action for surgeons to develop creative solutions to move the field forward. He pointed out that because there is no regulatory body for surgical procedures, surgeons must take it upon themselves to push new advances forward: “We have a degree of flexibility that few people in the care of patients and medicine have.” However, he cautioned that the professionalism of surgeons requires an understanding that what is new is not necessarily improved, and stressed the importance of communicating this concept to patients who often seek the latest treatment approaches.

While the concept of surgical ethics is still emerging, Dr. Angelos pointed out that many surgeons may already be practicing principles of surgical ethics without realizing it: “I think that if we’ve been practicing surgery in a thoughtful way and trying to care for our patients as individuals, we have in fact been practicing surgical ethics without even paying attention to it that way.”

This lecture was given in place of Peter A. Ubel, MD.

Additional Information: The Ethics Lecture, What's Different About Surgical Ethics and Why Does It Matter, was held October 25, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.